Attachment 2_VMMC Site Information.pdf

Attachment 2: Information on USAID-supported VMMC Sites

Province District Sub-district Site Type of Site Staffing Date of Site

Initiation

Location/Site Address Days and Hours of Operation

Target VMMC Counseling Social Mobilization Future Plans Key Challenges/

Barriers

Solutions to Challenges

Free State Lejwe Leputswa Matjhabeng Lesedi NGO based at Ernest Oppenheimer Private Mine Hospital

No dedicated VMMC staff.

Same staff used works at Lesedi Lechabile Primary Care's youth, men and women's clinic. Staff includes 10 Prof Nurses (6- 7 nurses per session or rotational basis except mini blitz sessions), 1 outreach coordinator (daily), 1 enrolled nursing assistant, 3 general assistants (1 per session on rotational basis), 10 counselors (5 per session on a rotational basis, 5 doctors (2 doctors per session between 2pm - 5pm weekdays and 3 during the mini blitz sessions)

Apr-11 MMC site located at Matjhabeng Local Municipality at 1 Power Road , Welkom, Free State.

Monday -Friday, mini blitz session targeting 60 patients per month.

100 patients per week and one mini blitz targeting 60 patients. 450 - 550 patients per month depending on the number of weeks per month.

A group session followed by individual counseling. Clients consent for VMMC and HCT. Most patients are tested at Men's clinic.

Social mobilization plan involves local partners within the district.

Planning to conduct a VMMC review service from a mobile clinic to improve accessibility to VMMC services at 4 sites:

Theunissen, Ventersburg, Allanridge and Hennenman (where Lesedi is 40 - 60km away from fixed site).

Only 50% people turn up for their appointment after confirmations. No equipment to test CD4 counts. There are only 4 Diathermy machines, thus limiting the number of VMMCs that can be done.

Professional nurses overworked, limited community outreach because professional nurses does not have time.

Door to door campaigns to attract clients. Clients are referred to nearest clinic to do CD4 count test to proceed with VMMC procedure. Maximized use of the diathermies to increase number of clients that could be circumcised within 3 hours.

Gauteng City of Johannesburg Region D Zola Clinic Specialized VMMC site within Community Clinic

One team Nov-10 Soweto Full time; Sat 09:00 -14:00

1000 per month Have in house communication strategy and team that mobilizes for VMMC Services.

Social mobilization team works together to mobilize for Zola using Interpersonal Communication, Radio, Billboards, Pamphlets.

Gauteng City of Johannesburg Region D Khula Ndoda Clinic Tertiary/ Academic One team with 2 doctors, 6 nurses, 2 counselors, 2 support staff (receptionist and data capturer). HIV HCT is outsourced

Nov-10 Chris Hani Hospital- Academic Hospital, 2nd Floor New OPD Building

Full time, Weekdays except public holiday/ 07:00 - 16:00

1000 per month MMC Counseling is conducted while HCT is outsourced to ZaziHCT and hospital

Newspaper adverts, community radio, shows, schools, churches, HCT site around Soweto

High demand & most people prefer VMMC on Saturday

Need more staff to reach 1 500 VMMC per month target

Gauteng City of Johannesburg Region G Orange Farm BP Stand Alone;

Specialized VMMC site in collaboration with Stretford clinic

One team/ Use Rotational staff for high Season and if VMMC demand increases

Jan-08 Orange Farm Township Full time and on Sat 09:00 -14:00

1000 per month Have HCT Teams.

HCT is conducted same day prior to surgery

Have in-house communication strategy and social mobilization teams.

Uses interpersonal communication, radio, billboards, pamphlets.

To be finalized Meeting the training demands as both sites are training centres.

Gauteng West Rand Merafong Carletonville District Hospital - Fixed site

1 permanent medical officer, 1 medical officer from the district rotates in on Wednesday only, 2 Professional Nurses, 3 Enrolled Nurses, 1 Admin Clerk, 1 Health promoter, 1 Counselor

Site launched on Dec 18, 2010, but VMMC initiated on Jan 21, 2011.

Corner of Falcon and Annan Street, Carletonville

5 days a week from 23 March 2011. Mon - Fri:

07:30 - 16:00

420 for the 1st three months and 630 per month thereafter

Clients counseled and tested on site, few come from other sites and have already been tested.

Information on VMMC and working relations were established with feeder clinics, counselors were trained in these clinics on VMMC specific counseling at their sites. Entered into partner agreements with social mobilization;

information material is distributed to clinics and taxi ranks.

Long traveling distance impedes accessibility to the VMMC site. Transport to go to VMMC services is costly.

Improve marketing strategy and involve field workers. Target FET Colleges and encourage students to do HCT and MMC. Engage school principals and school boards to get buy in to recruit secondary school learners. Establish relationship with local general practitioners that do not perform VMMC to refer patients to the VMMC site. Assist clients with transport to and from the VMMC site by buying a vehicle to ferry clients to VMMC sites.

Initiation

Location/Site Address Days and Hours of Operation

Target VMMC Counseling Social Mobilization Future Plans Key Challenges/

Barriers

Solutions to Challenges

Gauteng City of Johannesburg Region C Discoverers Community Health Centre - Fixed Site

2 Medical Officers, 2 Professional Nurses, 4 Enrolled Nurses, 2 Counselors, 1 Admin Clerk

23-Feb-11 35 Clarendon Street, Discovery, Florida, 1710.

Full time, Monday -Friday, 07:30 - 16:00

620 per month Counseling is done at designated counseling rooms by trained counselors.

HCT also done on site. Most clients are tested on site.

Hand outs standard

VMMC

pamphlets/leaflets to patients attending the clinic. Feeder clinics in the area book and refer patients for

VMMC.

Clients have problems of transportation to and from the site. No social marketing partner in the area hence low VMMC uptake

Meeting with stakeholders:

Sub-district management, local churches groups, local civil society organizations, taxi associations. Distribution of flyers at taxis and public transport centres. Use a programme transportation vehicle for ferrying outlying clients into the centre.

Gauteng City of Johannesburg Region B St Helen Joseph Hospital 1 doctor, 4 enrolled nurses, I data clerk, 1 counsellor

October-11 Perth Road, Auckland Park, Johannesburg, Gauteng, South Africa.

5 days a week:

Mon - Fri, 7:30 - 16:00

600 per month Conducted on site

Kwa Zulu Natal eThekwini eThekwini Northwest

St Aiden's Hospital Regional Hospital 1 full time doctor, 1 professinoal nurse, 3 enrolled nurses, 1 data capturer, 2 counselors on site. Supported by one

DOH/part-time doctor providing 2 hours support.

One program manager oversees and provides hands on support.

5-Apr-11 33 Centenary Road, Durban, eThekwini District, KwaZulu-

Natal

Mon-Fri: 8am-

4pm

850 HCT is provided on site for walk-in clients by 2 counselors. Most clients are prepared at PHC sites and receive HCT and eligibility screening at these facilities. 2 roving VMMC counselors support

PHC level VMMC counseling. Further specific VMMC counseling is provided at St Aiden's

Hospital pre and post-surgery.

Kwa Zulu Natal eThekwini eThekwini South Wentworth Hospital District Hospital 1 full time doctor, 1 professional nurse, 3 enrolled nurses, 1 data capturer and 2 counselors on site. Supported by one

DOH/part-time doctor providing 2 hours support.

One program manager oversees and provides hands on support.

21-Feb-11 Sidmouth Avenue, Wentworth, eThekwini District, KwaZulu-

Natal

Mon-Fri 8am-4pm 1050 HCT is provided on site for walk-in clients by 2 counselors. Most clients are prepared at PHC sites and receive HCT and eligibility screening at these facilities. 2 roving VMMC counselors support

PHC level VMMC counseling. Further specific VMMC counseling is provided at

Wentworth Hospital pre and post-surgery.

Kwa Zulu Natal eThekwini eThekwini North KwaMashu

Polyclinic

Community Hospital 1 team: 1 doctor, 4 nurses, 1 lay counselor

14-Oct-11 G1400, Bhejane Road, Kwamashu, 4359

5 days a week, 07:30-16:00

50 per day HCT is provided on site for walk-in clients by 2 counselors. Most clients are prepared at PHC sites and receive HCT and eligibility screening at these facilities. 2 roving VMMC counselors support

PHC level VMMC counseling.

Referral networks set up at nearby clinics

Main constraint has been the space - but that has been resolved.

Initiation

Location/Site Address Days and Hours of Operation

Target VMMC Counseling Social Mobilization Future Plans Key Challenges/

Barriers

Solutions to Challenges

Mpumalanga Ehlanzeni Bushbuckridge Mapulaneng

Hospital

District Hospital One team, including 1 doctor , 1 nurse (DoH), 1 enrolled nurse (DoH), 2 counselors for administrative work, VMMC HIV counseling and testing staff is shared with the ART Clinic, housed in the same building

Dec-10 Bushbuckridge Local Municipality, Ehlanzeni District, Mpumalanga Province Graskop Road , Mapulaneng

Full time, Weekdays Monday to Thursday except public holidays 07:00hrs- 16:00hrs; Half day Fridays;

07:30 -13:00hrs

400 per month VMMC specific counseling is conducted by 2 dedicated lay counselors. Prior to VMMC, clients are counseled in a group session as well as individually on VMMC and HIV. The facility integrates VMMC counseling with HCT.

Most clients are tested prior to MMC.

Two outreach officers drive the community mobilization. They mobilize community structures targeting clinics, schools, stokvel, churches, support groups, community members, imbizos, sports fields, local radio stations, and taxi ranks. Clinic nurses(Health workers),Teachers, Priests, Traditional healers, Indunas, headmen, Parents, general practitioners and Doctors, Political councilors at local wards

Tinstwalo currently non-operational due to shortage of staff but there are plans to offer technical support once Department of Health Recruits new staff

We have staff shortage problems. One Doctor, one professional nurse, and 2 ENA's were trained.

As time passed, the hospital took away one of the ENA's. It has been difficult to work with 3 people only. We have to circumcise, order drugs, etc. as well as counsel other special patients. As a result, demand outstrips supply of services with most patients waiting at least a month prior to getting services This situation forced us to book less people and we do less than we were supposed to do. The hospital says they cannot employ more staff.

We have clients booked till end of June and the numbers keep increasing.

Facility has capacity for 600 MMCs per month but is hampered by staffing shortages. There is sufficient demand to meet the target.

Mpumalanga Ehlanzeni Mjindi Barberton Hospital District Hospital 1 pediatric doctor,1 DoH rotating doctor, 1 DoH professional nurse, 1 enrolled nurse assistant, 1 administrator, 1 lay counselor

22-Feb-11 No: 1 Hospital Street Barberton 1300

5 days per week :

07:00 -16:00 on Mon- Thurs and 07:00-13:00 on Fri

200 per month HCT & VMMC counseling done at the Wellness Clinic due to space constrain at the VMMC Unit

Use of IEC material, reliance on word of mouth from circumcised clients, PHC and Clinic personnel talks given to patients

Effective programme marketing strategy, social mobilization, appoint a medical officer and 3 enrolled nurses

Distance from the VMMC sites poses a transport problem for clients in feeder areas. Poor community mobilization.

MOVE not yet implemented. Poor follow-up of patients.

Mobilize the community through HBC/DOT supporters/health promoters linked to PHC clinics; Book patients to be collected at clinics at specific dates; Discuss with hospital management to assist with the available HAS bus to collect people at the distant clinics

Mpumalanga Gert Sibande Mkhondo Piet Retief Hospital District Hospital 1 DoH doctor, 1 DoH professional nurse, 1 enrolled nurse, 1 enrolled nurse assistant, 1 administrator

30-Nov-10 Pretorius Street, Piet Retief

5 days per week:

07:00 -16:00 Mon- Thurs and 07:00- 13:00 on Fri

550 per month HCT & VMMC counseling done at the VMMC Unit

Use of IEC material, reliance on word of mouth from circumcised clients, PHC and Clinic personnel talks given to patients

Effective programme marketing strategy, social mobilization, appoint a medical officer on sessional basis and professional nurse full time

Poor community mobilization. Poor follow-up of Patients

Mobilize the community through HBC/DOT supporters/health promoters linked to PHC clinics; Book patients to be collected at clinics at specific dates; Discuss with hospital management to assist with the available HAS bus to collect people at the distant clinics

Mpumalanga Ehlanzeni Mbombela North Themba Hospital District Hospital 2 doctors (including 1 DoH doctor), 1 DoH professional nurse, 1 enrolled nurse , 3 DoH enrolled nurse assistants, 1 administrator, 2 lay counselors

9-Nov-10 1213 Kabokweni, Main Road

5 days per week 07:00 -16:00 Mon- Thurs and 07:00- 13:00 on Fri

660 per month HCT & VMMC counseling done at the VMMC Unit

Use of IEC material and word of mouth from circumcised clients

Effective programme marketing strategy, social mobilization, appoint professional nurse & enrolled nurse

Poor community mobilization. Poor follow-up of Patients

Mobilize the community through HBC/DOT supporters/health promoters linked to PHC clinics; Book patients to be collected at clinics at specific dates; Discuss with hospital management to assist with the available HAS bus to collect people at the distant clinics

Mpumalanga Ehlanzeni Nkomazi East Tonga Hospital District Hospital 2 rotating wellness doctors, 1 professional nurse, 2 DoH enrolled nurses, 1 administrator, 4 lay counselors, 1 driver

22-Nov-10 Tonga/Mangweni Road, Kwalugedlane 1341

5 days per week:

07:00 -16:00 Mon- Thurs and 07:00- 13:00 on Fri

660 per month HCT & VMMC counseling done at the VMMC Unit

Use of IEC material, reliance on word of mouth from circumcised clients, PHC and Clinic personnel talks given to patients, partnering with local AIDS Council on their community based activities

Appoint a medical officer, strengthen the relationship with Local AIDS Council on social mobilization

Lack of ownership of the programme by the hospital management and its personnel (doctors)

Continue advocating for the programme and to foster uptake of services by engaging all relevant stakeholders

Initiation

Location/Site Address Days and Hours of Operation

Target VMMC Counseling Social Mobilization Future Plans Key Challenges/

Barriers

Solutions to Challenges

Mpumalanga Ehlanzeni Nkomazi West Shongwe Hospital District Hospital DoH doctors rotating, 1 theatre professional nurse, 1 lay counselor

25-Mar-11 R570 Jepps Reef Road, Shongwe Mission

2 days per week, Tue & Thurs from 07:00- 16:00

120 per month HCT & VMMC counseling done at the Wellness Clinic due to space constrain at the VMMC Unit

Use of IEC material, reliance on word of mouth from circumcised clients, PHC and Clinic personnel talks given to patients

Effective programme marketing strategy, social mobilization, appoint a medical officer , professional nurse and lay counselor on seasonal basis

Poor community mobilization. Poor follow-up of Patients. Poor staffing

Fast track HR support Provide in-service training on MOVE model Develop and supply hospital with social mobilization plan Support social mobilization implementation